Intracytoplasmic Sperm Injection (ICSI) is one of the procedures, that is increasingly being used as a part of in vitro fertilization (IVF). The procedure involves a direct injection of a single sperm into the centre of the ovum (i.e. the human egg), though a small needle. The fertilized egg is then kept in the laboratory for three to five days, during which the embryo is formed and is directly placed into the uterus of the women.

This procedure is now used for more than half the cases of all in vitro fertilization treatments. It is highly effective in the management of male infertility (i.e. when the infertility in the couple is attributed to the male partner). Several international health tourism destinations provide ICSI procedure at subsidized rates, but with international quality and success rates. These tourism destinations include India in South East Asia, North Korea in East Asia, Jordan and Turkey in West Asia and Mexico in North America.

Need for Intracytoplasmic Sperm Injection (ICSI):

Intracytoplasmic Sperm Injection (ISCI) is one of the In vitro fertilization (IVF) techniques which is successfully used to overcome the problem of infertility which is attributed to the male counterpart,

When the male counterpart produces too few sperms. The condition is referred to as Oligozoospermia (i.e. the sperm count is less than 20 million sperms per milliliter of ejaculate). This procedure can be done using a donor sperm, when the male partner fails to produce any sperms i.e. Azoospermia.

The procedure is also effective in the management of male infertility which is caused due to anti-sperm antibodies, produced in the male counterpart, which simply destroy all the sperms that are ejaculated.

When the morphological structure of the sperm is abnormal or when the mobility of the sperm is poor (i.e. the sperms do not move fast enough to reach the ovum to fertilize it naturally).

The head of the sperm cannot penetrate the outer layer of the ovum.

A problem in the male reproductive system which may prevent the sperm from being ejaculated. This procedure can also help those males to have children who have undergone irreversible vasectomy.

Also the procedure has been proven useful in cases, where the women fail to produce adequate number of eggs as required for other IVF procedures.

Success Rate of Intracytoplasmic Sperm Injection (ICSI) procedure:

By using the Intracytoplasmic Sperm Injection (ICSI) procedure, almost 50% to 80% of the eggs get fertilized. However, certain eggs may get damaged during the procedure, while some fertilized eggs may not get transformed into embryo or the embryo stops growing altogether. As per studies conducted the average success rate of women under 35 years to conceive after an ICSI procedure is about 28-30%.

Intracytoplasmic Sperm Injection (ICSI): The procedure

The procedure involves separate intervention on the male partner and the female partner. The procedure requires both the male and female partner to be in the hospital to facilitate the process of sperm and ovum retrieval. The female is subsequently hospitalized for a period of two days after the procedure.

Intervention on the male partner:

The male partner is expected to produce the sperm sample prior to the procedure. However in most of the types of male infertilities, it is difficult for the male partner to ejaculate the sperm sample. Hence, the sperm is extracted directly by inserting a needle into the testicle under the effect of anesthesia.

In case the above procedure fails to retrieve an adequate number of sperms, the doctor takes a biopsy of the testicular tissue (which invariably has sperms attached to it). This procedure is referred to as Testicular Sperm Extraction (TSE).

The sperms retrieved are frozen and stored till they are used for fertilization.

Intervention on the female partner:

Similar to other standard in vitro fertilization (IVF) treatment procedures, the woman is given fertility drugs to stimulate the ovarian follicles in the ovaries and develop multiple mature eggs. Normally, a woman produces one egg per month; however with the support of fertility drugs, the female would develop multiple mature ovums.

Subsequently, under the effect of local anesthesia, all the mature eggs are removed from the ovary using a hollow and thin needle. The procedure is normally conducted under the guidance of an ultrasound, which helps the doctor to locate the exact position of the eggs.

The hence isolated eggs, are inoculated with the sperms collected from the male partner, by a laboratory technician, and are incubated for two days, to allow them to be transformed into embryos.

Subsequently, one or two of these embryos are transplanted into the uterus of the female using a thin catheter. A maximum of three embryos are transferred during one cycle.

The other embryos are cryo-frozen and stored to be used subsequently if this cycle fails.

Limitations of the Intracytoplasmic Sperm Injection (ICSI) procedure:

Unlike the natural procedure, where only the best of the sperms travel to fertilize the ovum, Intracytoplasmic Sperm Injection (ICSI) bypasses this natural process. Hence, it is believed that ICSI can result in higher rates of miscarriages and result in developmental and health problems among the children.

As per international study, it was found that nearly four percent of babies conceived by the process of ICSI had some major malformations. This malformation was most frequently observed in the male child and affected the urinary and reproductive system. This has raised doubts about the fertility of the children born using the ICSI technology.

Statistical studies have reported that children conceived using ICSI or any other IVF method are more likely to suffer from a major illness or may require medical intervention or surgery by the age of five years, as compared to children that are born naturally.

After Intracytoplasmic Sperm Injection (ICSI) procedure:

The woman is suggested to take a pregnancy test about two weeks after the embryo is implanted on the uterus. This is to confirm if the embryo is growing well and whether the pregnancy will continue.

Contemplating the risks of developmental malformations among ICSI conceived children, the couple is recommended to undergo routine and regular ultrasound scans during the first few months of pregnancy, to detect any malformations at an early stage.

Intracytoplasmic Sperm Injection (ICSI) in Jordan:

Morden technology, highly qualifed medical teams and state of the art medical care infrastructure has put Jordan on the global map as one of the most sought after medical tourism destinations. Jordan has been catering to the most of Middle East and attracts several medical tourists annually.

Intracytoplasmic Sperm Injection (ICSI) in South Korea:

Located in the Eastern corner of Asia, South Korea has recently augmented its healthcare infrastructure, to specifically cater to international medical tourists. Government interventions to enforce stringent regulations have contributed positively to raise the quality of medical care services to international standards

Intracytoplasmic Sperm Injection (ICSI) in India:

India is fast becoming one of the most preferred medical tourism destinations due to its good quality of care, hi-tech equipments and technology, and medical professionals with international repute. With evidence suggesting that medical care in India can cost as little as one-eight of the cost in the United States, it is one of the cheapest medical tourism destinations.

Intracytoplasmic Sperm Injection (ICSI) in Mexico:

With several JCI accredited hospitals, the country is ranked 61st by the World Health Organization for its robust and effective healthcare infrastructure. As Mexico borders the United States, many Americans prefer to visit Mexico for medical care, as it considerably reduces their travel time.

Intracytoplasmic Sperm Injection (ICSI) in Turkey:

As Turkey prepares to enter the European Union, it has strengthened its healthcare infrastructure, to meet the quality norms specified by the European Union. However, as it achieves these quality standards, its cost of medical care remains substantially lower than those in the Europe and United States. This is attracting several medical tourists annually to the country to seek good quality and low cost medical care services.

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